Association of GLP-1 Agonists With Postoperative Complications Following Knee Extensor Mechanism Repair:An Analysis of 1,092 Patients.

Abstract

Diabetes and obesity are recognized as risk factors for postoperative complications including increased surgical site infection (SSI) and reoperation in patients undergoing knee extensor mechanism repair. However, limited literature evaluates how preoperative glucagon-like peptide-1 (GLP-1) receptor agonist therapy may influence these outcomes. This study evaluated GLP-1 receptor agonist use as an independent risk factor for postoperative outcomes following knee extensor mechanism repair. Patients who underwent quadriceps or patellar tendon repair from 2012 to 2025 were identified in the TriNetX database and stratified by GLP-1 agonist use within 1 year of surgery. One-to-one propensity score matching yielded 2 well-balanced cohorts (n = 546). Postoperative complications were assessed at 90 days, 1 year, and 2 years, and Kaplan-Meier survival analysis was performed. No significant 90-day postoperative differences were observed. At 1 year, patients using GLP-1 agonists demonstrated significantly lower rates of SSI (2.38% vs 5.31%; odds ratio [OR] = 0.435; <i>P</i> = .0118) and wound complications (2.02% vs 5.31%; OR = 0.367; <i>P</i> = .0037). Differences persisted at 2 years, with lower rates of SSI (2.75% vs 6.04%; OR = 0.439; <i>P</i> = .0079), wound complications (2.38% vs 6.04%; OR = 0.379; <i>P</i> = .0026), and acute kidney injury (9.71% vs 13.55%; OR = 0.686; <i>P</i> = .0474). No significant differences in revision surgery were found. Kaplan-Meier analysis demonstrated significant separation for SSI and wound complications beginning at 1 year. Preoperative GLP-1 receptor agonist therapy was associated with reduced postoperative SSI and wound complications following knee extensor mechanism repair. These findings suggest potential for perioperative risk modulation as GLP-1 use becomes increasingly prevalent in patients undergoing knee extensor mechanism repair.